 |
| |
| Client Forms |
 |
|
If you're a first-time client, please review and complete the following
forms, bring them to your first session. There are 3 forms that need to be
completed. When you click on each form, it will take
you to a new window. Click on the print button on
the bottom of the page. When you are finished, close
window to come back here. |
|
|
|
|
|
|
| Monthly Membership
Enrollment Form |
|
|
|
|
|
|
|
Limitation of Confidentiality |
|
|
|
If you would like me to coordinate care with
your healthcare provider, please be aware that you must complete this
form to have records released. Insurance companies
and other third-party payers are given information that
they request regarding services to clients.
Information that may be requested includes type of
services, dates/times of services, diagnosis, treatment
plan, and description of impairment, progress of
therapy, case notes, and summaries. |
|
|
|
|
|
|
|
